Abstract
The careful study of clinical and investigative congenital heart disease is synonymous and intimately associated with the career of Julien I. E. Hoffman, MD, FRCP, a lifelong friend, mentor, and associate of countless individuals who have come under his influence in one way or another. He is part of the brain trust of the Cardiovascular Research Institute (CVRI), University of California–San Francisco, which included such individuals as Abraham Rudolf, Norman Silverman, Michael Heymann, and Paul Ebert, among many others. I was privileged to have been a clinical and research trainee of Paul Ebert during my residency and came into close contact with these enlightened investigators. It was a heady time to be a student. Radioactive microspheres were being used to define the fetal circulation; cardiac hemodynamics were refined to show the perils of ventricular hypertrophy in association with open heart surgery; and models of congenital heart surgery were being developed to better understand the problems of deep hypothermia/circulatory arrest, hemodilution, and myocardial preservation. Central to these global investigations was Julien Hoffman. He connected with each research fellow, he offered priceless guidance, and he served as the indefatigable role model that resulted in numerous successful disciples.
So now, he has written a single-authored textbook, The Natural and Unnatural History of Congenital Heart Disease, which was published in 2009 by Wiley-Blackwell. The book is a comprehensive review of congenital heart disease as practiced today, taking into consideration medical therapy, catheter-based interventions, and operative therapy. There are 55 chapters with ample references that cover the breadth of congenital heart disease with diagnostic and therapeutic discussions that are based on the available literature, which is the basis of his credo and lifelong assessment of congenital heart disease.
The chapters are succinct, informative, and based on laboratory as well as clinical investigations. The reference sections are invaluable to the clinician because the painstaking task of selecting the appropriate and informative manuscripts has already been performed by an experienced editor. Each chapter is highlighted by “Natural History” and “Unnatural History” of the disease entity. By expressing the outcomes in this manner, Dr Hoffman establishes the outcomes of the specific disease without intervention and with intervention. “Unnatural History” is especially important because with each intervention, catheter-based and operative therapy, a new category of congenital heart disease emerges, which will define the patient’s therapy for his or her remaining life. The method highlights the plain fact that in today’s world, there are more patients with congenital heart disease over the age of 18 years than there are below that age. “Unnatural History” therefore becomes extremely important if these patients are to benefit from our existing therapeutic options and future, as of yet, undiscovered applications.
These chapters are a delight to read. The text is informative and reflective of the analytical mind of the author. It is a great read for those who do not know Julien Hoffman, and it is a must read for those who do know Dr Hoffman and who want to visit with him from time to time through his genius.